Functional impact of rate irregularity in patients with heart failure and atrial fibrillation receiving cardiac resynchronization therapy

Aims Atrial fibrillation (AFib) with a rapid ventricular response may adversely impact cardiac performance, especially in patients with heart failure. However, it remains uncertain whether rhythm irregularity per se has unfavourable effects apart from tachycardia, and whether rate regularization alo...

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Bibliographic Details
Published in:European heart journal 2005-04, Vol.26 (7), p.705-711
Main Authors: Melenovsky, Vojtech, Hay, Ilan, Fetics, Barry J., Borlaug, Barry A., Kramer, Andrew, Pastore, Joseph M., Berger, Ronald, Kass, David A.
Format: Article
Language:English
Subjects:
Aged
Atrial fibrillation
Atrial Fibrillation - complications
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Biological and medical sciences
Biventricular pacing
Cardiac dysrhythmias
Cardiac Pacing, Artificial - adverse effects
Cardiac Pacing, Artificial - methods
Cardiology. Vascular system
Catheter Ablation - methods
Heart
Heart failure
Heart Failure - complications
Heart Failure - physiopathology
Heart failure, cardiogenic pulmonary edema, cardiac enlargement
Humans
Medical sciences
Physiology
Recovery of Function
Ventricular Dysfunction, Left - etiology
Ventricular Dysfunction, Left - physiopathology
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Summary:Aims Atrial fibrillation (AFib) with a rapid ventricular response may adversely impact cardiac performance, especially in patients with heart failure. However, it remains uncertain whether rhythm irregularity per se has unfavourable effects apart from tachycardia, and whether rate regularization alone can improve heart function. Methods and results Nine subjects with chronic AFib, atrioventricular nodal block, and symptomatic heart failure (ejection fraction 14–30%) were studied using a pressure–volume catheter. Ventricles were biventricularly paced (RV-apex, LV-lateral wall) at 80 or 120 min−1 mean rate, using regular or irregular, Poisson-distributed stimulation. At 80 min−1, ventricular function was similar between the two pacing modes. However, at 120 min−1, irregular pacing impaired systolic (dP/dtmax: −8.2%, P
ISSN:0195-668X
1522-9645
DOI:10.1093/eurheartj/ehi066